Data collection and data analysis
The data used in this study were taken from the critical
indicators for benchmarking used in the RAFAELA
system, sent annually from hospitals to the company
responsible for maintaining the system, who in turn
publishes annual reports (Fagerstro¨m & Rauhala 2007).
The system’s critical indicators consist of two larger
units of data, ward-related information and informa-tion on NI. For the purposes of this study, the following
indicators were assessed: ward-related information,
such as number of beds, number of nurses, nursing staff
employment structure (skill mix), reliability rating (gi-ven as a percentage); and information on NI such as
number of daily patient classifications, NI per day, NI
per patient, NI per nurse, and reference values of opti-mal NI level for each ward. The data were compiled
into an Excel table and thereafter analysed using the MS
EXCE L2000 spreadsheet program. Descriptive statistics
are presented in Tables 1–5.
Results
Presentation of wards
The size of the wards looked at in this study varied from
20 to 40 beds. Seven wards out of nine had more than
30 beds. The mean number of beds on surgical units
was 36.5, whereas the mean number on internal medi-cine units was 28 and on neurology units 29.5. The
smallest ward, counting only 20 beds, was specially
developed for infectious disease patients and contained
isolation facilities.
All of the participating wards personnel nurse re-sources, including skill mix, are presented in Table 1. In
Finland, assistant nurses have a vocational education,
achieved after 2 to 3 years of post-secondary school
education. Approximately 15 years ago, the Finnish
Ministry of Social Affairs and Health chose to cease the
registration of Clinical Nurse Specialists. Thus, amongst
the registered nurses, there are nurses both with and
without further specialization education and/or exams.
During 2006, the mean of personnel nurse resources
was 24.5, during 2007 it was 23.5. The number of
nurses per ward varied from 20.5 to 34 (including head
nurse, assistant head nurse, registered nurses and
assistant nurses). The nurse-to-patient ratio was calcu-lated for each ward and year. Hospital C had the lowest
nurse-to-patient ratio (0.55–0.66) and Hospital B the
highest (0.8–1.08). The mean nurse-to-patient ratio for
all wards was 0.79.
In accordance with the RAFAELA system s quality
assurance system, the reliability of the nurses daily
patient classifications is tested annually through parallel
classifications. This entails that two nurses classify
approximately 150 patients on each ward indepen-dently of one another. Only 1–2 wards were not able to
provide a reliability value of over 70%. The mean
reliability value was 73.2% for 2006 and 78.7% for
2007